Racial and ethnic disparities in quality of care among patients with newly-diagnosed glaucoma– a multicenter study

Abstract

Purpose : Racial and ethnic minorities experience higher rates of blindness from primary open-angle glaucoma (POAG) compared with non-minorities. Yet, little is known on whether this disparity is due to differences in quality of care received, differential loss to follow-up, or other factors.

Methods : We identified adults with newly diagnosed POAG across 12 US health systems in the SOURCE Ophthalmology Big Data consortium (2010-2022). Eligible patients were required to have ≥1 eye visit in a 2-year lookback period prior to their incident POAG diagnosis, elevated IOP, and no record of glaucoma treatment during that period. We calculated the mean drop in median IOP between the 12 months prior to initial diagnosis and at the 12-18 months follow-up. We determined the proportion of patients experiencing an IOP drop ≥15% and assessed how this varied by race and ethnicity. We also determined the proportion of patients lost to follow-up after incident POAG, how that varied by race and ethnicity, and created a logistic regression model to adjust for potential confounding factors.

Results : There were 1030 eligible patients (628 White, 306 Black, 28 Asian, 52 Latino) with incident POAG. The mean drop in median IOP OD/OS during the 12-18 months of follow-up was 5.0/5.6, 4.6/4.8, and 7.1/5.1 mmHg, for White, Black, and Asian patients, respectively. The percentage of adults with newly diagnosed POAG whose IOP OD dropped ≥15% was higher for Whites (65.8%) compared with Blacks (59.0%) (p=0.05) and slightly higher for non-Hispanics (63.9%) vs. Latinos (61.5%) (p=0.84). Blacks with newly diagnosed POAG had a higher loss to follow-up (34.8%) compared with Whites (24.4%) and Asians (28.2%) (p< 0.0001); Latinos had a greater loss to follow-up (45.3%) compared to non-Hispanics (28.2%) (p< 0.001). After adjusting for social determinants of health, Blacks had 66% higher odds of loss to follow-up (OR 1.66, CI 1.02-2.68) compared with Whites.

Conclusions : Fewer racial minority patients with newly diagnosed POAG achieve an IOP drop ≥15% in the 12-18 months after initial diagnosis and more racial and ethnic minority patients are lost to follow-up. These disparities may contribute to worse clinical outcomes and highlight the importance of addressing factors that may limit racial and ethnic minorities from accessing IOP-lowering treatments and follow-up care.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Logistic regression model of patients lost to follow-up